Pledge Form

Yes or No Yes or No Yes! I/We will support PCUU with pledge or donation! No, I/we choose not to support PCUU with pledge or donation.

Recognition Options Recognition Options Our name(s) not dollar amount) can be used publicly Please keep our names confidential

"No" alternatives "No" alternatives I/we will counsel with the minister about alternatives I/We will be ending our membership and off the mailing list effective at current year's end. Other

"Other" explanation

Name 1

Phone 1

Email 1

Name 2

Phone 2

Email 2

Street Address

City, State and Zip

My/Our_annual_pledge_amount_for_2022_will_be:

payment method payment method Cash Check Stock Auto withdrawal (EFT) (please provide a voided check to PCUU)

payment amount

frequency frequency Monthly Quarterly Yearly Other

Pledge_Treasurer_will_send_spring,_summer_and_year-end_reports_on_your_pledge/donation_status._Please_indicate_how_you_would_like_to_receive_these. Pledge_Treasurer_will_send_spring,_summer_and_year-end_reports_on_your_pledge/donation_status._Please_indicate_how_you_would_like_to_receive_these. Email US Mail No reports, please

Type_your_full_name_to_serve_as_your_signature.